The influence of dietary advice on nutrient intake during pregnancy

To assess the effect of an antenatal nutrition programme designed specifically for the local population, questionnaires on nutrition knowledge, attitudes to healthier eating and 4 d diet diaries were completed by women attending routine antenatal clinics. Women who received the nutrition education programme were allocated into an Intervention Education Group whilst those women who did not were allocated into a Routine Education Group. The results showed that knowledge about nutrition was significantly higher in the intervention group. However, no significant differences were detected between the two groups for attitude variables or nutrient intake. It is concluded, therefore, that the most-widely-read form of nutrition advice for pregnant women may have some impact on nutrition knowledge but has little effect on nutrient intake during pregnancy.

Ability to distinguish whisky (uisge beatha) from brandy (cognac)

OBJECTIVE

To assess ability to distinguish between first rate malt whisky and brandy and between different brands of each.

DESIGN

Crossover with two sessions of 12 blindfold tastings of two whiskies and two brandies before and after supper, repeated not more than seven days later.

SETTING

Dundas, Ontario.

PARTICIPANTS

4 volunteers aged 50-68 years, all moderate drinkers of alcohol and members of a wine club.

MAIN OUTCOME MEASURES

Proportion of samples correctly identified (whisky v brandy) and, of those, the proportion of brands correctly identified.

RESULTS

Only one participant produced irrefutable statistical evidence (P < 0.0001) of being able to distinguish between whisky and brandy, correctly identifying 50/51 (98%) samples. Two participants achieved some success in identification (72%, P = 0.0031 and 65% P = 0.031). The fourth participant's responses reflected pure guesswork. Brandy was no easier to identify than whisky (P = 0.84). The participant who was best able to distinguish between whisky and brandy was also best able to identify correctly the brand of whisky (100%, P < 0.0001).

CONCLUSION

Despite the fact that not all participants completed the full number of tastings the results show that some participants could distinguish neither between malt whisky and brandy nor between different brands of whisky and brandy. However, the success of one participant shows that "it can be done" and that his whisky specific ability is acquired not innate.

Public health medicine advice to local authorities: does it happen?

The views of public health physicians on the extent and quality of their specialty's collaboration with local government in Scotland was ascertained by postal questionnaire. Responses were received from 84 out of 97 (85%) Consultants in Public Health Medicine (CPHMs) working in Scottish health boards. Those working in health boards were more likely than colleagues in university departments to consider their service department to be sufficiently aware of and involved in issues having a bearing on health but not directly related to provision of health services (48/70 vs 4/12, RR 2.1, 95% CI 1.1-3.8). Seventy CPHMs gave advice to local authorities. They were in contact with a median of two local authority departments (range 0-6); most commonly Social Work (38 CPHMs), Environmental Health (36), and Education (26). CPHMs participated in a median of one multi-disciplinary group (range 0-3); most commonly Health Promotion (16 CPHMs), Child Welfare (9), Emergency Planning (9). The majority, 42 of 67 (63%), valued this contact highly, only three considering it of doubtful utility. Difficulties with bringing an item to the attention of a local authority department were identified by six out of 56 (11%) CPHMs and 32/69 (46%) recorded problems in ensuring Public Health Medicine input to local authority committees. In most health boards (12/14) there were formal meetings between CPHMs and heads of local authority departments; in each these were supplemented by informal meetings. One Director of Public Health and eight other CPHMs reported neither formal nor informal contact with local authorities. Spontaneous comments from respondents indicated a desire to strengthen the links with local authority departments.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal glucose response to a standardized test meal throughout pregnancy and postnatally

OBJECTIVE

Our purpose was to determine the maternal blood glucose response to food throughout pregnancy.

STUDY DESIGN

Forty-five normal, healthy primiparous women with singleton pregnancies were studied longitudinally throughout pregnancy. Blood glucose levels were determined at each stage of pregnancy after a standardized test meal.

RESULTS

Fasting plasma glucose decreased throughout gestation and rose again significantly post partum. Glucose values at 30, 60, 90, and 120 minutes after a standardized test meal were similar at all gestational ages studied.

CONCLUSIONS

Plasma glucose levels after a physiologic challenge with food do not alter with advancing gestation. This has implications both for the management of insulin-dependent diabetes during pregnancy and for the diagnosis of gestational diabetes.

Laboratory examination for Cryptosporidium spp in Scotland

AIMS

To ascertain the present practices of Scottish microbiological laboratories for examining faecal samples for Cryptosporidium spp and to compare these with practices elsewhere.

METHOD

A questionnaire was circulated to all 35 Scottish NHS bacteriological laboratories, where human stool samples are subjected to routine microbiological examination, to determine current laboratory testing methods and selection criteria used to examine faecal specimens for Cryptosporidium spp.

RESULTS

All laboratories responded, of which the first began testing in 1984 and the last in 1990. At 15 sites all diagnostic stool samples submitted are routinely examined for Cryptosporidium spp. Elsewhere, selection criteria, principally based on age, specific request, and foreign travel, are used. The age distribution of Scottish cases differed significantly from that of the PHLS study of 16 laboratories (p < 0.001), probably as a result of the selection criteria used. The phenol-auramine staining procedure is used by 19 laboratories, with modified Ziehl-Neelsen staining used by 14 laboratories; eight used a second, confirmatory method.

CONCLUSIONS

Currently applied selection criteria for examination of stools for Cryptosporidium in Scotland do not accord with published epidemiological data. Specimen selection based on age of patient and stool consistency may lead to cases of public health importance being missed. Nationally agreed criteria for testing of human samples based on epidemiological evidence are required.

High-resolution NMR study of the pressure-induced unfolding of lysozyme

The pressure-induced reversible unfolding of lysozyme was investigated by high-resolution proton magnetic resonance spectroscopy by following the proton spectra of the following residues: His-15 epsilon 1, Trp-28 epsilon 3, Leu-17 delta 2, Cys-64 alpha, and Trp-108 epsilon 3. The experiments were performed at pH 3.9 and 68.5 degrees C in the pressure range from 1 bar to 5 kbar both in the absence and presence of tri-N-acetylglucosamine (tri-NAG). From the pressure-induced changes of the equilibrium between the native and denatured forms of lysozyme, the reaction volumes (delta V) were calculated for each residue. Small but statistically significant differences in delta V were found for residues located in different regions of the protein. For example, delta V for the disulfide bonded Cys-64 alpha is smaller than the delta V's found for the other residues. In particular, the effect of tri-NAG binding to lysozyme was a change of delta V from -10.3 +/- 0.6 cm3/mol to -18.1 +/- 1.7 cm3/mol for the Trp-108 epsilon 3 residue which is located close to the active site. It is important to note that the Cys-64 alpha residue also senses the binding of the substrate analog. The ability to detect statistically significant differences for delta V of individual residues located in different regions of lysozyme represents the main result of these experiments.

Introducing the new schedule--a health board's experience

On 1st October 1990 a revised primary immunisation schedule was introduced throughout Scotland. Following a review of current practice, Argyll and Clyde Health Board adopted a distinct implementation strategy. A questionnaire study of the 461 likely providers of primary immunisations or advice was performed to review this process. Sixty-four percent responded within 21 days. Over 90% were satisfied with the information supplied on the change. Almost equal proportions of immunisers were using 2, 4, 6 and 2, 3, 4 month schedules. The commonest sources of immunisation advice were the Health Board Immunisation Manual and the JCVI 'Green Book'. Twenty percent of responders volunteered that primary immunisation should have some statutory basis. The outcome of this change in terms of reduced morbidity and increased vaccine uptake will require active monitoring through concomitant changes in general practice remuneration make this difficult. The role of the Standard Immunisation Recall System requires re-examination.

Does labetalol influence the development of proteinuria in pregnancy hypertension? A randomised controlled study

It is the development of proteinuria in pregnancy-induced hypertension which is associated with an increased perinatal mortality. There is some evidence to suggest that labetalol may diminish the amount of proteinuria in patients who have already developed proteinuric pre-eclampsia. A randomised controlled study design was used to investigate whether labetalol treatment, started when a persistent diastolic blood pressure greater than 90 mmHg was observed, influenced the subsequent development of proteinuria. One hundred and fourteen women with singleton pregnancies and hypertension in the absence of proteinuria were randomised to receive either labetalol or no antihypertensive therapy. At recruitment maternal age, blood pressure and gestation were similar in both the labetalol and control groups. There was no difference in the frequency, quantity or timing of subsequent proteinuria between treatment and control groups. Overall 34% of primigravidae and 10% of parous women developed proteinuria. Labetalol did, however, control the blood pressure in 45 of the 51 treated women (88%) within 24 h. This effect was often shortlived requiring dose escalation after 3 to 5 days in the majority of cases. Labetalol was well tolerated and no significant maternal toxicity was noted.

Duodenal carcinoid tumour associated with gastric leiomyoblastoma

We describe the synchronous occurrence of carcinoid tumour of the duodenum and leiomyoblastoma of the stomach in a patient presenting with anaemia. This combination of primary tumours has not previously been described.

Breech delivery and epidural analgesia

OBJECTIVE

To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks).

DESIGN

A retrospective study.

SETTING

Data Bank, Aberdeen Maternity Hospital.

SUBJECTS

643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term.

OUTCOME MEASURES

Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates.

RESULTS

Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65).

CONCLUSION

Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.

Radiologically controlled balloon dilatation of rectal strictures

Rectal stricture is a well recognized complication following anterior resection. It is traditionally managed with metal dilators or resection. This paper describes the use of balloon dilatation for benign anastomotic rectal strictures. Eight patients were included in the trial. Only one dilatation was necessary in four patients while the remaining four patients required further dilatation for relief of symptoms. The mean diameter of the stricture increased from 7.2 mm to 17.0 mm post-dilatation. There were no complications associated with the procedure. Balloon dilatation is a safe and effective method of treating benign anastomotic rectal strictures.

Ciliary sulcus anatomical dimensions

Trans-scleral ciliary sulcus and iris suture fixation of posterior chamber intraocular lenses (IOLs) in eyes without posterior capsular support are techniques gaining wider acceptance. Primary indications are IOL exchange in pseudophakic bullous keratopathy and secondary IOL insertion in aphakia. Accurate placement of the posterior chamber lens loops within the ciliary sulcus is based on knowledge of ciliary sulcus anatomy. Nineteen postmortem eyes were sectioned in the coronal plane to expose the posterior iris border and the ciliary body. Ciliary sulcus diameters were measured, and the mean diameter was 11.0 +/- 0.37 mm. The mean limbus-ciliary sulcus distance was then measured by passing 26-gauge needles through the ciliary sulcus and sclera. The mean limbus-ciliary sulcus distance was 0.9 mm. These measurements may guide ophthalmic surgeons in choosing appropriate IOL designs for IOL exchange or secondary IOL procedures.

Neonatal listeriosis in Scotland

Thirty-one cases of neonatal listeriosis occurred in Scotland between 1 January 1987 and 31 August 1989. In each of these, Listeria monocytogenes was cultured from blood, cerebrospinal fluid or both. No case of neonatal listeriosis occurred between 1 September 1989 and 31 July 1990, a statistically significant difference in incidence (p less than 0.001). A possible explanation may be that pregnant women adjusted their diet in accordance with the advice given by the Chief Medical Officer in his letter to General Practitioners of February 1989 entitled 'Food and Listeriosis'. Full clinical features and outcome of nineteen of the thirty-one cases were obtained from the paediatricians responsible for their care. Of these, sixteen were early onset and three late onset cases. There were eight deaths, all early onset cases. Two severely asphyxiated infants could not be resuscitated and of the five infants who required assisted ventilation from birth, four died. Four early onset and three late onset cases presented with pyogenic meningitis and all seven recovered without sequelae. It is concluded that when neonatal listeriosis presents as an asphyxiated infant who, after resuscitation, requires assisted ventilation, a fatal outcome is probable. When neonatal listeriosis presents as pyogenic meningitis, recovery without sequelae is the usual outcome.

Estimated fetal weight in twin pregnancy: how good are we?

Ultrasonic assessment of fetal weight derived from multiple measurements of the fetus has become accepted in clinical practice as being useful in singleton pregnancies. Several different formulae for estimating fetal weight have been derived from differing measurements of the fetus, such as biparietal diameter, trunk circumference, and femur length. To date, there has been no attempt to evaluate such a technique in multiple pregnancy. This study aims to see whether the formulae derived for singleton pregnancy are applicable to twin pregnancies. Estimated fetal weight will be derived by mathematical modelling from ultrasonic measurements made within a week of delivery and the results compared with the actual birthweight to give an indication of how good such estimated fetal weights are. Factors to be considered in the analysis include whether there are differences between Twin I and Twin II, differences of presentation with twins and differences by gestation at delivery.

Growth patterns in preterm and term twin deliveries

Preterm deliveries in singleton pregnancies have been shown to be associated with decreased rate of growth in utero. A total of 113 sets of twins were scanned serially at fortnightly intervals to establish fetal growth. There was no significant difference in the growth pattern in twins delivered before 37 weeks compared to those delivered after this time.

Human listeriosis in Scotland 1967-1988

In order to study the epidemiology of listeriosis from 1967-1988 in Scotland, various sources of data were examined. These included reports by laboratories, reference laboratory records, hospital death and discharge records, death certificates and hospital laboratory records. Cases were reported from 13 of Scotland's 15 Health Boards. Case ascertainment via laboratory reports to the Communicable Diseases (Scotland) Unit was validated in two Health Boards. A total of 198 cases was identified with an overall attack rate which increased from 0.5 per million in 1967-1971 to 7.0 per million in 1987-1988. Feto-maternal cases were the commonest (64%). Of all cases, 33% were neonates; 53% presented with bacteraemia and 41% with meningitis. The predominant serovar of Listeria monocytogenes was 4b.